New directions in emergency medicine

There's been a dramatic increase in the use of bedside ultrasound in emergency rooms in St. John's in the last few years, and members of Memorial's new Discipline of Emergency Medicine are actively involved in teaching and research in this area.

Dr. Tia Renouf is chair of the Discipline of Emergency Medicine and she explained that bedside ultrasound is different from a radiology-based ultrasound. "Radiology ultrasounds attempt to characterize a specific region of the body, identifying many subtle differences and pathologies," she said. "This takes many years of training as a radiologist. Bedside ultrasound is often used to answer distinct clinical questions within minutes."

Dr. Renouf is enthusiastic about the work ahead in building the discipline and creating a world class site for emergency medicine teaching. In particular she wants to improve continuing medical education for doctors in rural areas.

"The challenge for doctors working in rural areas is to maintain proficiency," she said. "Now there are better ways to serve rural physicians and their patients through innovations like ultrasound."

Dr. Andrew Smith has been working closely with Dr. Renouf. A formal training program has been implemented for all emergency room physicians working in the St. John's emergency departments, and this work has facilitated the development of several master instructors and training centre designation from the Canadian Emergency Ultrasound Society.

"This allows us to train emergency room and other practising physicians' skills in emergency ultrasound both in Newfoundland and Labrador and the country," said Dr. Smith. "This will facilitate the training of rural physicians' advanced skills that lead to improved patient care and decreased system costs."

Dr. Renouf said all emergency room physicians in St. John's have undergone formal bedside ultrasound training over the past year, with more than half having completed advanced training.

The use of ultrasound at the bedside was brought into clinical use in the emergency department, and has quickly spread to most areas of medicine such as pediatrics, surgery and internal medicine. "Ultrasound can be used to actually watch the needle tip go exactly where it needs to go during procedures," said Dr. Smith. "This has led to a dramatic improvement in patient safety resulting in lower complications rates, lower infection rates and fewer attempts per procedure."

Over the past year, Memorial has partnered with Dalhousie University and the other Maritime provinces to form the collaborative Atlantic Point of Care Ultrasound research group and this is now expanding to include multiple institutions across the country. Memorial is also actively involved in enrolling patients in an international multi-centered trial using bedside ultrasound in cardiac arrest. "This is a great example of leadership coming from Memorial, Dalhousie and the Atlantic provinces," said Dr. Smith.

Drs. Renouf and Smith are working with the dean of medicine, Dr. James Rourke, to develop a multidisciplinary bedside ultrasound training programs for Memorial residents. "While most universities across the country have formal bedside ultrasound training programs, they are mostly emergency room or specialty specific," explained Dr. Smith. "We are working on the development of a truly multidisciplinary approach geared towards teaching each specific discipline the skills that will enhance their practice and help care for their patients."